Adhesions
are bands of scar tissue that form between organs. In the abdomen,
they form after an abdominal surgery or after a bout of
intra-abdominal
infection (ie, pelvic inflammatory disease, diverticulitis).
More than 95% of patients who undergo abdominal surgery develop
adhesions; these are almost inevitably part of the body’s healing
process.
Although most adhesions are
asymptomatic,
some can cause bowel obstructions, infertility, and chronic pain. In
a study that reviewed over 18,912 patients who underwent previous
open abdominal surgery, 14.3% presented with a bowel
obstruction in 2 years, with 2.6% of these patients requiring
adhesiolysis to relieve the bowel obstruction. Postoperative
adhesions account for 74% of cases of small-bowel obstruction. Kista
endometriosis is one of the most common etiologies because
peritoneal
lesions activate a chronic extensive inflammatory process, leading to
dense adhesions. In fact, kista endometriosis-related adhesions are
so common that the American
Society for Reproductive Medicine (ASRM) assigns more points to
adhesions for the staging of kista endometriosis than it does to the
disease itself.
Laparotomy with open adhesiolysis has
been the treatment of choice for acute complete bowel
obstructions. Patients who have partial obstructions, with soame
enteric contents traversing the obstruction, may also require surgery
if nonoperative measures fail. However, operation often leads to
formation of new intra-abdominal adhesions in 10-30% of patients,
which may necessitate another laparotomy for recurrent bowel
obstruction in the future.
Laparoscopic adhesiolysis was
successfully used by Dr Vijayavel for the treatment of severe bowel
obstruction in one patient with a multiple adhesive band. The patient
experience painful periods and painful sex as the bowels were stuck
to the uterus. Dr Vijayavel released the bowels from the uterus
successfully using laparascopic
adhesiolysis technique.
Compared with the open approach to
adhesiolysis, the laparoscopic approach offers the following:
- Less postoperative pain
- Decreased incidence of ventral hernia
- Reduced recovery time with earlier return of bowel function
- Shorter hospital stay
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